I 112th CONGRESS 1st Session H. R. 1654 IN THE HOUSE OF REPRESENTATIVES April 15, 2011 Mr. Schrader (for himself, Mr. Kissell, Mr. Larson of Connecticut, Ms. Baldwin, Mr. Kucinich, and Mr. Farr) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to provide for additional opportunities to enroll under part B of the Medicare Program, and for other purposes.

1.

Short title

This Act may be cited as the Medicare Enrollment Protection Act of 2011.

2.

Medicare part B special enrollment period for individuals enrolled in COBRA continuation coverage

(a)

Special enrollment period

Section 1837(i) of the Social Security Act (42 U.S.C. 1395p(i)) is amended by adding at the end the following new paragraph: (5)(A)In the case of an individual who— (i)at the time the individual first satisfies paragraph (1) or (2) of section 1836, is enrolled in COBRA continuation coverage (as defined in subparagraph (D)), and (ii)has elected not to enroll (or to be deemed enrolled) under this section during the individual's initial enrollment period, there shall be a special enrollment period described in subparagraph (B).(B)The special enrollment period referred to in subparagraph (A) is the period including each month during any part of which the individual is enrolled in COBRA continuation coverage ending with the last day of the eighth consecutive month in which the individual is at no time so enrolled. (C)An individual may only enroll during the special enrollment period provided under subparagraph (B) one time during the individual's lifetime. (D)For purposes of this paragraph, the term COBRA continuation coverage means continuation coverage provided pursuant to part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (other than under section 609), title XXII of the Public Health Service Act, section 4980B of the Internal Revenue Code of 1986 (other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines), or section 8905a of title 5, United States Code, or under a State program that provides comparable continuation coverage. Such term does not include coverage under a health flexible spending arrangement under a cafeteria plan within the meaning of section 125 of the Internal Revenue Code of 1986. . (b)

Coverage period

Section 1838(e) of such Act (42 U.S.C. 1395q(e)) is amended— (1)by striking pursuant to section 1837(i)(3) or 1837(i)(4)(B) and inserting the following: pursuant to—(1)section 1837(i)(3) or 1837(i)(4)(B)— ; (2)by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving the indentation of each such subparagraph 2 ems to the right; (3)by striking the period at the end of the subparagraph (B), as so redesignated, and inserting ; or; and (4)by adding at the end the following new paragraph: (2)section 1837(i)(5), the coverage period shall begin on the first day of the month following the month in which the individual so enrolls. . (c)

No increase in premium

Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is amended— (1)in the first sentence, by inserting , (i)(5), after subsection (i)(4); and (2)in the second sentence, by inserting before the period at the end the following: or months for which the individual can demonstrate that the individual was enrolled in COBRA continuation coverage (as such term is defined in section 1837(i)(5)(D)).. (d)

Effective date

(1)

In general

The amendments made by this section shall take effect on the date of the enactment of this Act and shall apply to periods of COBRA continuation coverage before, on, or after such date. (2)

Special enrollment period

No special enrollment period under section 1837(i)(5)(B) of the Social Security Act (42 U.S.C. 1395p(i)(5)(B)) shall begin before the first day of the first month that begins at least 45 days after the date of the enactment of this Act. (3)

Premiums

The amendment made by subsection (c)(2) shall apply to premiums for months beginning with the first month that begins at least 45 days after the date of the enactment of this Act.

3.

Continuous open Medicare part B enrollment

(a)

Continuous open enrollment period

Section 1837 of the Social Security Act (42 U.S.C. 1395p) is amended by adding at the end the following new subsection: (m)(1)There shall be a continuous open enrollment period beginning on the first day of the first month in which an individual first satisfies paragraph (1) or (2) of section 1836, except that such continuous open enrollment period shall not be available during the individual’s initial enrollment period or a special enrollment period available to the individual. (2)In the case of an individual seeking enrollment under paragraph (1) during a general enrollment period under subsection (e), the individual shall be enrolled under such subsection and not under paragraph (1), unless the individual specifies otherwise. . (b)

Coverage period

Section 1838(a)(2) of such Act (42 U.S.C. 1395q(a)(2)) is amended— (1)in subparagraph (E), by striking the semicolon and inserting a comma; and (2)by adding at the end the following new subparagraph: (F)in the case of an individual who enrolls pursuant to subsection (m) of section 1837, the first day of the month following the month in which such individual so enrolls; or . (c)

Premium increase

Section 1839 of such Act (42 U.S.C. 1395r) is amended by adding at the end the following new subsection: (j)

Increase in premium based on enrollment pursuant to continuous open enrollment period

In the case of an individual whose coverage period began pursuant to a continuous open enrollment period under section 1837(m), the monthly premium determined under subsection (a), adjusted in accordance with subsection (i), shall, in addition to the increase required by subsection (b), be increased by such amount as the Secretary considers appropriate, taking into account any additional actuarial cost to the insurance program established under this part due to enrollment under such section. Any increase under this subsection shall apply to all premiums paid by the individual after enrollment pursuant to such continuous open enrollment period. . (d)

Report to Congress

Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report describing— (1)the average increase in premiums based on enrollment in the insurance program established under part B of title XVIII of the Social Security Act pursuant to a continuous open enrollment period under section 1837(m) of such Act, as added by subsection (a); (2)any other regulations promulgated by the Secretary with respect to such enrollment; (3)the number and characteristics of individuals choosing such enrollment; and (4)any costs of such enrollment to such insurance program that were not covered by the increases in premiums described in the amendment made by subsection (c). (e)

Effective date

The amendments made by this section shall take effect on the date of the enactment of this Act, except that no individual may enroll pursuant to a continuous open enrollment period under the amendment made by subsection (a) before the first day of the first month that begins at least 45 days after the date of the enactment of this Act.

4.

Special enrollment periods to correct error, misrepresentation, or inaction of Federal Government, group health plan, or plan sponsor

Section 1837(h) of the Social Security Act (42 U.S.C. 1395p(h)) is amended by inserting or by an officer, employee, or agent of a group health plan, or of a plan sponsor (as such term is defined in section 3(16)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(16)(B))) of a group health plan, after instrumentalities,.

5.

Coordination of Medicare part B with American Health Benefit Exchanges

Section 1837 of the Social Security Act (42 U.S.C. 1395p), as amended by section 3(a), is further amended by adding at the end the following new subsection: (n)The Secretary shall ensure appropriate coordination between the insurance program established under this part and American Health Benefit Exchanges established under section 1311(b) of the Patient Protection and Affordable Care Act (Public Law 111–148), including ensuring a smooth transition in enrollment from enrollment in qualified health plans offered through Exchanges to enrollment under this part. .

6.

GAO study and report on Medicare part B enrollment

Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on enrollment in the insurance program established under part B of title XVIII of the Social Security Act (in this section referred to as Medicare part B). The report shall include— (1)a comprehensive evaluation of problems experienced by individuals with respect to enrollment in Medicare part B, including the causes of such problems and any geographic trends in the manifestation of such problems; (2)an assessment of the number of people who lack health insurance coverage because of such problems; (3)an evaluation of efforts by the Centers for Medicare & Medicaid Services and the Social Security Administration to educate employers regarding the transition of employees from group health plans to Medicare part B; (4)an evaluation of coordination of coverage for individuals with private health insurance who are also eligible for Medicare part B and ways to improve such coordination; (5)an evaluation of the coordination between Medicare part B and American Health Benefit Exchanges required by the amendment made by section 5; (6)an evaluation of the differences in regulations applicable to individuals who are eligible for Medicare part B based on age and individuals who are eligible based on disability, and ways to improve parity in the treatment of each such group of individuals that may be implemented in regulations and guidance; and (7)an evaluation of efforts by the Centers for Medicare & Medicaid Services to provide equitable relief to individuals who suffered adverse consequences due to misinformation or a lack of information on enrollment in Medicare part B, and ways to improve the provision of such equitable relief.